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The rough road ahead for the Southbury Training School

October 12, 2011

Late last month, the families and guardians of the residents of the Southbury Training School learned a little about the rocky political road ahead for their loved ones at STS.

First, in response to a Freedom of Information request, we received a memo from the Department of Developmental Services, dated June 23, 2011, which laid out a six-year closure scenario for STS. 

The memo cites last year’s Messier federal court decision, which, it notes, provides a “framework for making a professional judgment about every person’s ability to live in the most integrated setting…”  Translation: the decision provides a mechanism for persuading guardians of residents at STS to move their loved ones into privatized group homes. 

Then there was the Program Review and Investigations Committee’s preliminary report on September 27, which garnered headlines across the state with its conclusion that it costs more than two and a half times as much per client to operate STS than a private group home in Connecticut.   

We strongly dispute the Program Review Committee’s conclusion, and hope to make the case in coming months on this site and elsewhere that STS provides cost-effective care to more than 400 of the state’s most profoundly intellectually disabled residents.  We believe the opponents of publicly delivered care are overstating STS’s cost per resident and understating the cost of privately provided, community-based care. 

We hope Rep. T.R. Rowe of Trumbull, the co-chair of the Program Review Committee, will keep an open mind on the cost issue.  Rowe  told the Associated Press before the Committee’s preliminary report was even released that the state could save “hundreds of millions of dollars a year” in moving STS residents into private group homes.   His comments would seem to go beyond even the findings of the Committee’s preliminary report. 

STS’s entire budget for the current fiscal year is $95.5 million, according to the Department of Developmental Services, so it’s hard to see how the state could save hundreds of millions of dollars per year even if the school were shut down today.  Moreover, if STS were shut down, DDS would still have to continue to pay for the care of the 425 residents who would be transferred from STS to community-based group homes.  And that doesn’t count the cost of building the new homes that would have to house them. 

We have our work cut out for us in slowing the political momentum against STS.  A public hearing held by the Program Review Committee on September 27 was stocked with nonprofit provider advocates, who have long sought to close STS.  And DDS appears to be on their side.  At the hearing, DDS Commissioner Terrence Macy, a former provider executive director, termed the current DDS system of care, which funds both public facilities and private group homes, “an unsustainable paradigm.” 

Macy stated that 17 STS residents have already chosen to leave the facility and that he has approved the development of two new group homes for STS residents.  We fully support STS residents’ individual choices about where they want to live, but we, too, want to make sure their choices are fully informed.

On Rep. Rowe’s website, another lawmaker is quoted as saying that the residential care for people with intellectual disabilities is “far less expensive when handled by the private sector, which maintains the same standards of care and patient safety.”  

This is not correct.  The standards for private and public sector care are not the same.  STS and the five smaller public regional Intermediate Care Facilities (ICFs) in Connecticut are held to a higher federal standard of care than are the vast majority of privately run group homes in the state, which operate under a waiver of federal standards under Title 19 of the Social Security Act. 

Martha Dwyer, an STS family member, testified at the Program Review Committee hearing about how a  lower level of supervision in a private group home led to the death of a former STS resident, 27 days after he had left his long-time home at STS.  The resident, a former roommate of Martha’s brother at STS, choked on a hotdog in the group home after he grabbed the hotdog, unsupervised, from a refrigerator. 

Here are a few additional points to keep in mind about STS, the role it plays in the continuum of care overseen by DDS and the whole cost issue:

  • STS serves some of the most intellectually disabled residents in Connecticut.  The Program Review report noted that 79 percent of the residents at STS have severe or profound levels of intellectual disability, the highest percentage of any care setting in the state.  In contrast, only 35 percent of the residents of the privately run group homes in the state have a severe or profound diagnosis, while 62 percent of private ICF residents in the state have those levels of disability. 
  • The STS budget subsidizes some 500 community-based residents with dental care as well as other community-based services.  (The STS Home & School Association has filed a Freedom of Information Act request for DDS records showing the STS budget for the past several fiscal years.)
  • The Program Review Committee did not appear to determine exactly which DDS services are covered in the per diem rates used to make its cost comparisons.  Were the same services being compared across all care settings?  At the Sept. 27 hearing, for instance, one guardian of a privately run group home testified that she pays for her son’s dental hygiene costs out of pocket. 
  • At STS, clinical, therapeutic, nursing, medical, and dental services are all provided on site, and we believe they are all part of the STS budget.  Among those on staff is a clinical psychiatrist who knows the residents and their histories. In the private group home system, residents must usually go off site to get access to medical, clinical, and other services, which tend to be offered on a less consistent basis than at STS.  (The STS Home & School Association has asked DDS for a list of all STS employees and for sample contracts of care in privately run group homes and private ICFs in Connecticut.)

There are other factors that we think make STS more cost effective to operate than private group homes, when apples-to-apples comparisons are made.  One is the centralization of services at STS, which largely eliminates costs of transporting clients to day programs, and to medical, clinical, and therapeutic appointments.

Secondly, we believe public management of care at STS and in public group homes is potentially less expensive than the private contracting system because the private providers are run by managers and executives who are paid far more on average than are public managers.  The Program Review report noted that 40 out of 75 group home providers in Connecticut, whose cost reports the Committee reviewed, paid their executive directors salaries exceeding $100,000 a year. 

In addition, there were a number of cases in which the providers paid out large “management fees,” which “appear to circumvent the statutory requirement for transparent reporting of an agency’s (provider’s) Executive Director’s salary,” the Committee report stated.

We would also note that state and federal oversight of care and conditions at STS is much more comprehensive than oversight of the widely dispersed group home system.  As a result, we believe there is a greater potential for abuse and neglect of residents in group homes than at state facilities such as STS. 

Yet, as Hugo Dwyer, Martha Dwyer’s brother, testified at the September 27 hearing, STS is often wrongly portrayed by its opponents as “conjuring up images of overcrowding and negligence, of patients living in filth.”    Nothing, in fact, could be further from the truth,” Hugo Dwyer said.  As he noted:

At STS, residents live in cottages and apartments, all quite similar to group homes, that offer similar comforts and community involvement… STS provides a safe and expansive setting to allow maximum independence.  Families of the residents at STS do not want our loved ones moved out of STS.  We believe that the life that would await them in smaller settings would be more isolating, offer less oversight and protection, and have a higher potential for tragedy.

Residential cottage at STS

Dwyer pointed out in his testimony that his brother, Tom, a resident at STS with profound intellectual disability and complex medical problems, has a “level of comfort and familiarity at STS that are vital to his well-being.”  The staff are trained to address his dietary requirements and his tendency to ingest foreign objects, a condition known as PICA.

Similarly, Barb Roberts-Hirsch says the staff at STS has become expert over a 20-year period in monitoring the psychological condition of her brother, Art, an STS resident, who has been diagnosed with manic depressive schizophrenia in addition to having a mild intellectual disability.  The staff psychiatrist’s knowledge of Art’s condition and his medications has prevented full-blown psychotic episodes, she said.  “Thus far, no community agency has been able to offer this care,” Barb said. 

The bottom line is that we don’t think the case has been made to close STS and that closure of the center will not provide any budgetary savings to the state.  On the other hand, closing STS will prove to be extremely disruptive and harmful to many, if not most, of the center’s longtime residents.  And it will only lengthen the waiting time for care and services for thousands of other intellectually disabled persons in Connecticut who are competing for the limited residential resources available from DDS. 

It’s time to recognize that STS is an integral part of the continuum of care for the intellectually disabled in Connecticut and that the center can and should continue to co-exist with the private system of care.  The intensive care available at STS is not needed by all, or even most, of those with intellectual disabilities in the state, but it is needed by the current residents.  STS’s care also continues to be needed as well by hundreds of DDS clients in the community.

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10 Comments
  1. Hugo Dwyer permalink

    Thank you, Dave. This is a good assessment of where we stand, and how we differ from many who support a move to 100% privatization of facilities. The State of Connecticut appears to be talking only of costs, and while you address many of the faults and fallacies in their argument, I think it is important to remind them that there are other considerations. Safety of the clients is the most important factor, but we must remember that with this population, consistency of treatment and a sense of stability and security contribute greatly to their well-being.

  2. As a Parent of a 50 year + daughter who has Down syndrome I have always advocated for choices and options for where my daughter or any one else lives, works or plays.

    I have visited STS many times in the past and in fact am an advocate for a man who lives there,

    The question is not weather he should be living in the community or at STS but what does he or in my case the man or his GUARDIAN want.

    Now I know the man I advocate for is blind and has many other problems which I will not go into would not get the care he gets in STS.

    I have spend many years working with organizations and the DDS to improve the lives of the people with disabilites in Connecticut and I believe we have made many improvements.

    My daughter lives in a group home and is doing great but more and more towns and cities don’t even want a group home in their back yard.

    If we are going to treat the people at STS as human being and citizens of Connecticut than we need to step back, take another look at what some of us are trying to do to some of our citizens.

    We have many DDS clients living in Nursing homes where they are not getting any where near the care the people at STS are getting.

    We need to wake up and do what is the right thing for the people at STS

    The citizens of Connecticut need to stand up and support my daughter and all the rest in Connecticut who need your help.

    THE ONE SIZE SHOE FITS ALL concept does not work.

    WHAT WOULD YOU DO IF SOMEONE CAME TO YOUR DOOR AND SAID YOU HAVE TO LEAVE AND GO SOMEWHERE ELSE would you just say OK thanks and go?

  3. deb carver kloszewski permalink

    After spending a multitude of time attempting to find services of equal or better care in the community for medical and dental care, I have determined that THERE IS NO OPTION AVAILABLE FOR CARE equal to the medical care my brother receives at STS. I have spoken with numerous specialists, internists, dentists endodontists. They do not accept title 19 clients. Hence, the clients end up at clinics like Yale, St.Raphael’s walkin and they see a different doc every time. You are playing with fire when you have a client that is on mental health meds and someone wants to “try” something else. Continuity is the key in this case. So, a group home setting is not the same.
    Picture this scenario: Your mother and dad are in their late eighties and enjoying life living in their home. They are able to take care of each other and the quality of life is good. Also, they have lived in this house since they were first married. Approximately 60 years. All of a sudden, for no reason at all, except to save money, the family comes along and says time to go to a nursing home mom and dad or time to take the car keys away. these are devastating to seniors. We as their children dread the day we have to make these decisions. Well, every client at STS is a senior or close to it. The majority have lived there their whole lives. What a cruel thing to do to them. Just because someone says it will save thousands of dollars. I don’t agree obviously. We are not talking about animals or cars. These are people. They have challenges. They also have feelings, and needs. There is safety for the clients at STS. They will not be taken advantage of. They are supervised, they are not left in a car in a parking lot, nor left to take a hotdog and choke on it. I would invite the members of the committees to hold their meetings at STS in one of the kitchens in a cottage and spend a day following a group of people who live there. Sounds like the politicians don’t have a clue as to the care received at STS. I can only hope that their family members that have to go into skilled nursing facilities receive the care our relative do at STS.

  4. Marietta Stone Anastas permalink

    Our family had our brother, “A”, living at STS since he was 7 years old. He passed away last April at age 63. Our brother was profoundly retarded with the approximate mental age of 6 months to 1 year. During his years at STS, he received the most wonderful, loving, healthcare, schooling, and socializing, that anyone could have hoped for.

    As our parents aged,and finally died, I became our brother’s guardian, and worked directly with the caretaking staff, on-site medical and dental personnel, his daycare providers, physical, speech therapists,and the dietary staff to meet all of the special needs required by our brother over the years. I can’t begin to explain that the overall care our brother received was all on-site, and we never, ever, worried that he was going to be neglected. The cottage staff that worked with “A” were there for years and years — the longevity of their employment was amazing. These folks were his extended family,and loved him as if they were his real family. The staff, just by virtue of working with these very specially-challenged folks, were experts in dealing with their very special needs on a minute-by-minute, day-by-day basis.

    You can never convince me or my family that these types of services will be found in a privately run group home. This State of Connecicut will isolate these special people, and they will be dehumanized because staffing will turn over quickly, and as these folks become ill, they will be put into nursing facilities that will be poorly equipped to handle the profound special needs. That is where you will find real neglect rearing its ugly head. It may sound like pie-in-the-sky wishfulness to think that the private group homes can meet these challenges, but it is impossible for these profoundly retarded special people.

    Yes, some mentally challenged individuals with higher functioning levels may do well in group homes scattered throughout the State, but we are not talking about those folks. Families of special needs persons should have the choice as to where they find the care to meet the needs of their loved ones. With that said, families of special needs persons who have their loved ones at STS should also have the choice to leave them there forever without the looming fear that STS will be taken away.

    To our State Reps, this is not about dollars and cents – this is about human rights, and acting responsibly. Personally, I believe you will be signing death warrants by forcing these older specially challenged individuals out into community settings ill-equipped to meet their needs. You still have to build the institutions you are talking about … they currently don’t even exist … its all talk .. retoric … where is that $$ coming from in our fiscally-strapped State? In addition, there are most likely hundreds of families in Connecticut desperately looking to find a safe, total encumpassing facility to meet the needs of their loved ones. I find it so short-sighted of our government officials to look away from STS instead of “AT” STS to see what they can do to make this phenomenal facility/community ever better than it is is. It is an amazing place – and you are blind if you can’t see it. The campus is beautiful – and you are letting the physical buildings decay because of political pressures. It’s all about choice — ours to keep our loved ones in their homes, if we, as guardians, choose it. I am and always will be an advocate for STS. Now with the oversight guidelines in place, maybe it’s time to think about creating another STS community in another part of the state so that families with profoundly retarded/special needs family members will have the choice between STS or its duplicate. Why recreate the wheel — we’ve got the best model going.

  5. Anonymous permalink

    It is astonishing to me that, at a time of serious fiscal stringency in the Connecticut state government, there should be such a push to destroy this valuable facility. Not only does it provide excellent care for its residents, but it generates millions of dollars a year in revenue from the Federal Government. It serves the local community buy providing the services of medical specialists, dental care, and physical and occupational therapy to handicapped people who live in the community and depend on its services for some of their medical and dental supports. It will be extremely expensive to close the school, and will take years to begin to realize savings — if, indeed, there are savings to be realized. Many studies in other states and at Southbury have shown that savings are not to be anticipated if the entire cost of community care is taken into account.

  6. Philip K. Bondy, M.D. permalink

    I am astonished that the State of Connecticut should be considering closing Southbury Training School at a time of serious financial stringency in the State budget. The school provides services to over 400 severely retarded people who will require expensive care no matter where they live. The School is much more efficient in providing these services than would be scattered community residences. Moreover, the School generates millions of dollars of revenue for the State annually through reimbursement from the Federal Government. Repeated studies by the legislature and by outside experts have shown that the cost per person of operating facilities like Southbury is is no greater than the cost of providing equivalent services in the community. In addition, one should consider the extensive services Southbury offers to DDS clients who live in the community. The experienced medical, dental and therapy staff at Southbury provide extensive services to these DDS clients. Such services — especially dental care — are often difficult for DDS clients to find in their community. The training school is a valuable facility which should be cherished and promoted for the services it can offer to the community as well as to its residents.

  7. My brother, George who is about to turn 67, has lived at STS since he was 4 years old. That’s 63 years. It is his home. That it would remain his home was the pledge of the state.

    Vermont, where I live, closed its similar facilities in Waterbury and Brandon a number of years ago to “save money”. I was President of the Board of the Counseling Service of Addison County (CSAC) which is the state designated provider of services in Addison County. During my six year direct involvement in these issues it was clear that this was just about money, not quality of life or service. State revenues have been under pressure for sometime. CSAC funding has not kept up with the cost of living. Level budgets or cuts across the board (“everybody has to share the pain”) are the rule, and the clients suffer, mostly out of sight. If I thought George would receive better treatment or care in the Vermont system (in the community), we would have moved him here a number of years ago. He is best served where he is. Nothing I have seen has made me feel otherwise.

    I agree with Hugo Dwyer. This is about more than money and the justifications presented. This is about quality of life. As George’s guardian, I speak for him and his family. We want him to stay at STS.

  8. Linda M. permalink

    Thank you, Mr. Kassel for informing us in this way. It’s really helpful to have email notification of all that is going on and being able to comment. It reminds us not to forget our loved one and what’s happening in his world. Our parents have both passed away recently, but all through the 54 years our brother has been there, they were always in touch with the staff at STS and of course, our brother. Now, we would like to pick up where they left off, but we live across the country and aren’t able to keep track of what’s going on as we would like.

    Our family is like most of those who have commented – our brother is 61 and has been at STS since he was 8. To imagine him anywhere else is so unsettling, since his health has declined and his main problem is Autism, so staying within the normal patterns are of the utmost importance to him, but we know all who are there desire this as well.

    Not sure if this has been suggested or if it’s possible, but instead of keeping the entire “sprawling” STS property as in the past, can’t it be pared down to a more appropriate size as it is now caring for the needs of just the 400 (approx) who are still there? Wouldn’t this would open up so much of the property for other ventures as well as make the School less of a burden on the State’s finances?

    • Linda, thanks for your comment. Yes, your idea of reducing the STS “footprint” is definitely worth considering. In Massachusetts, guardians of the residents of the Fernald Developmental Center have long proposed a “postage-stamp” arrangement, under which most of that developmental center’s 200-acre campus would be made available for development, while the existing ICF would remain on a portion of the campus. Unfortunately the Patrick administration has not been willing even to discuss the proposal. They are bent on closing Fernald and three other ICFs in that state and will not negotiate or consider any alternative to that. Maybe the Malloy administration in Connecticut will be more open to an arrangement such as the one you’re suggesting. Let’s hope!

  9. Ruth Harney permalink

    I worked at STS in the Cytogenetics Research Lab when Dr. Herman Yannet was the Medical Director, and I can attest to the fact that the residents received excellent care. Long after leaving my position, I volunteered as a reading tutor in a boys’ cottage.

    While I am a strong advocate for the STS type care, I will agree that there should be the option of group home care. Having recently visited a group home many times in Westchester, I can attest to the fact that socialization in a community setting and medical care was superior at STS. There is no comparison.

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